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Revised 7/1/05 Mandatory Participation Physical Evaluation HISTORY FORM Date of Exam Name Sex Age Date of birth Grade School Sport(s) Address Phone Personal Physician In case of emergency, contact:

How to fill out preparticipation physical evaluation history

How to fill out a preparticipation physical evaluation history:

1. Gather all relevant medical records and information about your health history. This includes previous injuries, surgeries, illnesses, and any chronic medical conditions you may have.
2. Begin with personal information: Fill in your name, date of birth, address, and contact information. This will help identify your records accurately.
3. Complete the section regarding your family medical history. Provide information about any genetic or hereditary conditions that run in your family, such as heart disease, cancer, diabetes, or mental health disorders.
4. Fill out the section on your current medications. List any prescription drugs, over-the-counter medications, or supplements you are currently taking. Include the dosage and frequency of each medication.
5. Provide information about any allergies you have, including drug allergies, food allergies, and environmental allergies. Be specific about the reactions you experience when exposed to these allergens.
6. Document any previous injuries or surgeries you have undergone. Include the type of injury or procedure, the date it occurred, and any ongoing or residual effects.
7. Fill in the section on medical conditions. List any chronic or recurring medical conditions you have been diagnosed with, such as asthma, epilepsy, diabetes, or high blood pressure.
8. Answer questions related to your cardiovascular health. This may include questions about any heart conditions, chest pain, or episodes of fainting or dizziness during exercise or physical activity.
9. Provide information about your immunization history. Include the dates and types of vaccinations you have received, such as tetanus, influenza, and meningitis vaccines.
10. Finally, sign and date the form to certify that the information you provided is accurate and complete.

Who needs a preparticipation physical evaluation history?

A preparticipation physical evaluation history is typically required for individuals participating in organized sports activities or athletic programs. This may include student-athletes, recreational athletes, and professionals in various sports. The evaluation helps to ensure that individuals are medically fit to engage in physical activity, identify any underlying health conditions that may require special attention or precautions, and establish a baseline for future health monitoring. Coaches, sports organizations, and medical professionals may require this evaluation history to prioritize the health and safety of individuals participating in physical activities.

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What is preparticipation physical evaluation history?

Preparticipation physical evaluation history is a form filled out by athletes prior to participating in sports activities to assess their medical history and fitness for participation.

Who is required to file preparticipation physical evaluation history?

All athletes are required to file preparticipation physical evaluation history before participating in sports activities.

How to fill out preparticipation physical evaluation history?

Athletes can fill out preparticipation physical evaluation history by providing accurate information about their medical history, current health status, and any previous injuries.

What is the purpose of preparticipation physical evaluation history?

The purpose of preparticipation physical evaluation history is to ensure the safety and well-being of athletes by identifying any potential health risks or conditions that may affect their ability to participate in sports activities.

What information must be reported on preparticipation physical evaluation history?

Information such as medical history, previous injuries, current medications, allergies, and any existing health conditions must be reported on preparticipation physical evaluation history.

How do I execute preparticipation physical evaluation history online?

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